CLINICAL RESEARCH pyrig

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The Coronally Advanced Flap in ss e n c e
fo r

Combination with Platelet-rich Fibrin

(PRF) and Enamel Matrix Derivative
in the Treatment of Gingival
Recession: A Comparative Study
Sasha Jankovic, DDS, PhD
4DIPPM
PG
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6OJWFSTJUZ
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4FSCJB

Zoran Aleksic, DDS, PhD

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Iva Milinkovic, DDS

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Bozidar Dimitrijevic, DDS, PhD

4DIPPM
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Correspondence to: Dr Sasha Jankovic

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260
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
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advanced flap (CAF) and to compare it SPPU
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Materials and methods:

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(3

BQJDP Conclusions:
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DPSPOBM
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PG
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8,5

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1%
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PG
13'
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Results:
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PG
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(Eur J Esthet Dent 2010;5:260–273)

261
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
70-6.&

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PG
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262
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
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related proteins derived from porcine SFDFTTJPO

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263
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
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Fig 1

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MPDBM
BOFTUIFTJB
SPPU
EFCSJEFNFOU
XBT

UIBU
QSFTFOUFE
POF
PS
NPSF
UFFUI
XJUI
B
QFSGPSNFE
XJUI
VMUSBTPOJDT
BOE
IBOE

HJOHJWBM
JOEFY
IJHIFS
UIBO

BGUFS
JOJUJBM
DVSFUUFT
'JH


"O
JOUSBTVMDVMBS
JODJTJPO

UIFSBQZ
XFSF
FYDMVEFE
GSPN
UIF
TUVEZ
XBT
NBEF
XJUI
B
OP$
CMBEF
PO
UIF

1BUJFOUT
XJUI
TZTUFNJD
DPOUSBJOEJDBUJPOT
CVDDBM
BTQFDU
PG
UIF
UPPUI
PS
UFFUI
CFJOH

UP
QFSJPEPOUBM
TVSHFSZ
VOEFS
BOZ
NFEJ USFBUFE
)PSJ[POUBM
JODJTJPOT
XFSF
NBEF

DBUJPO
LOPXO
UP
DBVTF
HJOHJWBM
FOMBSHF BU
UIF
JOUFSQSPYJNBM
DFNFOUPFOBNFM
KVOD
NFOU
BOEPS
UBLJOH
BOUJDPBHVMBOUT
UJPO
$&+

MFWFM
PG
UIF
QBQJMMBF
BEKBDFOU

XFSF
BMTP
FYDMVEFE
GSPN
UIF
TUVEZ
UP
UIF
UPPUI
PS
UFFUI
CFJOH
USFBUFE
5IFTF

5IF
TUVEZ
VTFE
B
TQMJUNPVUI
EFTJHO
IPSJ[POUBM
JODJTJPOT
XFSF
FYUFOEFE
TP

JO
XIJDI
UXP
UFFUI
QSFTFOUJOH
XJUI
HJOHJ BT
OPU
UP
JOWPMWF
UIF
HJOHJWBM
NBSHJO
PG

WBM
SFDFTTJPO
TVJUBCMF
GPS
UIF
SPPU
DPWFS UIF
BEKBDFOU
UFFUI
5XP
PCMJRVF
SFMFBT
BHF
XFSF
SBOEPNMZ
BTTJHOFE
UP
POF
PG
JOH
JODJTJPOT
XFSF
NBEF
BU
UIF
NFTJBM

UXP
USFBUNFOU
HSPVQT
B
$"'
DPNCJOFE
BOE
EJTUBM
FOET
PG
UIF
IPSJ[POUBM
JODJTJPO

XJUI
&.%
&.%
HSPVQ

PS
B
$"'
DPN BOE
FYUFOEFE
CFZPOE
UIF
NVDPHJOHJ
CJOFE
XJUI
13'
13'
HSPVQ

3BOEPNJ WBM
KVODUJPO
"
GVMMUIJDLOFTT
nBQ
XBT
FM
[BUJPO
PG
UIF
UXP
USFBUNFOU
HSPVQT
XBT
FWBUFE
UP
FYQPTF
BU
MFBTU

NN
PG
UIF

QFSGPSNFE
CZ
UIF
UPTT
PG
B
DPJO
#PUI
NBSHJOBM
CPOF
BQJDBM
UP
UIF
EFIJTDFODF

USFBUNFOU
QSPDFEVSFT
XFSF
QFSGPSNFE
BSFB
'JH


"
IPSJ[POUBM
SFMFBTJOH
JODJ
CZ
UIF
TBNF
PQFSBUPS
1SJPS
UP
TVSHFSZ
JO
TJPO
XBT
NBEF
JO
UIF
QFSJPTUFVN
BU
UIF

CPUI
USFBUNFOU
HSPVQT
JOJUJBM
QFSJPEPO CBTF
PG
UIF
nBQ
UP
BMMPX
GPS
B
UFOTJPOGSFF

264
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
"656./

 JANKOVIC ET ALopyrig
No C

ht
t fo
rP

by N
ub

Q ui
lica
tio
te ot n

n
ss e n c e
fo r

Fig 3

&OBNFM
NBUSJY
EFSJWBUJWF
&.%

USFBUNFOU
Fig 4

&OBNFM
NBUSJY
EFSJWBUJWF
USFBUNFOU
HSPVQ

HSPVQ
UPPUI


&.%
CFJOH
BQQMJFE
UP
UIF
SPPU
TVS UPPUI


5IF
nBQ
XBT
DPSPOBMMZ
BEWBODFE
BOE

GBDF TVUVSFE
XJUI

FYQBOEFE
QPMZUFUSBnVPSPFUIZMFOF

DPSPOBM
EJTQMBDFNFOU
PG
UIF
nBQ
5IF

SPPU
TVSGBDF
XBT
DPOEJUJPOFE
XJUI


EDTA (ethylenediaminetetraacetic acid)
HFM
GPS

NJOVUFT
DPQJPVTMZ
SJOTFE
XJUI

XBUFS
ESJFE
XJUI
B
HBV[F

JO
Y

JO
BOE

USFBUFE
XJUI
&.%
BT
SFDPNNFOEFE
CZ

UIF
NBOVGBDUVSFS
'JH


5IF
$"'
XBT

TFDVSFE
DPSPOBM
UP
UIF
$&+
MFWFM
CZ
TV
UVSJOH
JU
UP
UIF
QBQJMMBF
XJUI

TVUVSFT

'JH


5IF
PCMJRVF
SFMFBTJOH
JODJTJPOT

XFSF
DMPTFE
XJUI
JOUFSSVQUFE
TVUVSFT
Fig 5

&OBNFM
NBUSJY
EFSJWBUJWF
USFBUNFOU
HSPVQ

UPPUI


5XFMWFNPOUI
QPTUPQFSBUJWF
WJFX
TIPX
The PRF protocol JOH
DPNQMFUF
SPPU
DPWFSBHF

"
CMPPE
TBNQMF
XBT
UBLFO
XJUIPVU
BOUJ
DPBHVMBOU
JO
B
NM
UVCF
XIJDI
XBT

JNNFEJBUFMZ
DFOUSJGVHFE
BU

SQN

BQQSPYJNBUFMZ

H

GPS

NJOVUFT

#MPPE
QSPDFTTJOH
XJUI
B
DFOUSJGVHF
GPS

13'
BMMPXT
UIF
DPNQPTJUJPO
PG
B
TUSVD
UVSFE
mCSJO
DMPU
JO
UIF
NJEEMF
PG
UIF
UVCF

KVTU
CFUXFFO
UIF
SFE
DPSQVTDMFT
BU
UIF

CPUUPN
BOE
BDFMMVMBS
QMBTNB
BU
UIF
UPQ

'JH


"GUFS
DPMMFDUJPO
PG
UIF
13'
JUTFMG

SFTJTUBOU
BVUPMPHPVT
mCSJO
NFNCSBOFT

BSF
FBTJMZ
PCUBJOFE
CZ
ESJWJOH
PVU
UIF
Fig 6

5IF
QSFQBSBUJPO
PG
QMBUFMFUSJDI
mCSJO
13'


TFSVN
GSPN
UIF
DMPU
'JH

 13'
DMPU
SFNPWBM

265
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
"656./

 CLINICAL RESEARCH pyrig
No Co

ht
t fo
rP

by N
ub

Q ui
lica
tio
te ot n

n
ss e n c e
fo r

Fig 7

"VUPMPHPVT
QMBUFMFUSJDI
mCSJO
NFNCSBOF
Fig 8

1MBUFMFUSJDI
mCSJO
USFBUNFOU
HSPVQ
1SF
PCUBJOFE
CZ
ESJWJOH
PVU
UIF
TFSVN
GSPN
UIF
DMPU PQFSBUJWF
WJFX
TIPXJOH
HJOHJWBM
SFDFTTJPO
.JMMFS

$MBTT
*

PO
UPPUI


Fig 9

1MBUFMFUSJDI
mCSJO
USFBUNFOU
HSPVQ
UPPUI
Fig 10

1MBUFMFUSJDI
mCSJO
13'

USFBUNFOU
HSPVQ



"
CVDDBM
nBQ
XBT
FMFWBUFE
GPMMPXJOH
SPPU
QSFQ UPPUI


'PMMPXJOH
UIF
QSFQBSBUJPO
PG
13'
B
13'

BSBUJPO NFNCSBOF
XBT
TVUVSFE
JO
UIF
SFDJQJFOU
BSFB
XJUI


TJML

Fig 11

$PSPOBMMZ
BEWBODFE
nBQ
TVUVSFE
PWFS
Fig 12

1MBUFMFUSJDI
mCSJO
USFBUNFOU
HSPVQ
UPPUI

DPOOFDUJWF
UJTTVF
HSBGU 

5XFMWFNPOUI
QPTUPQFSBUJWF
WJFX
TIPXJOH

DPNQMFUF
SPPU
DPWFSBHF

266
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
"656./

 JANKOVIC ET ALopyrig
No C

ht
t fo
rP

by N
ub

Q ui
lica
tio
te n ot

n
5IF
13'
HSPVQ
XBT
USFBUFE
XJUI
TPNF
ss e n c e fo r
NPEJmDBUJPOT
PG
UIF
UFDIOJRVF
EFTDSJCFE

CZ
-BOHFS
BOE
-BOHFS
'PMMPXJOH
MPDBM

BOFTUIFTJB
SPPU
TVSGBDFT
JO
UIF
SFHJPO

CFUXFFO
UIF
CPUUPN
PG
UIF
TVMDVT
BOE

UIF
$&+
XFSF
TDBMFE
BOE
QMBOFE
XJUI

IBOE
BOE
VMUSBTPOJD
EFWJDFT
'JH


"O

JOJUJBM
JOUSBTVMDVMBS
JODJTJPO
XBT
NBEF
JO

the recession area of the tooth or teeth ■ &.%
o
DPSPOBMMZ
BEWBODFE
nBQ
DPNCJOFE
XJUI
FOBNFM
NBUSJY
EFSJWBUJWF
HSPVQ
■ 13'
o
DPSPOBMMZ
BEWBODFE
nBQ
DPNCJOFE
XJUI
13'
HSPVQ

XIFSF
SPPU
DPWFSBHF
XBT
JOUFOEFE
5IF





(3
o
DIBOHF
JO
HJOHJWBM
SFDFTTJPO
JO
NJMMJNFUFST

8,5
o
DIBOHF
JO
UIF
BQJDPDPSPOBM
XJEUI
PG
UIF
LFSBUJOJ[FE
UJTTVF
JO
NJMMJNFUFST





1%
o
DIBOHF
JO
QPDLFU
EFQUI
JO
NJMMJNJUFST
JOUSBTVMDVMBS
JODJTJPO
XBT
FYUFOEFE
UP

UIF
NFTJBM
BOE
EJTUBM
MJOF
BOHMFT
PG
UIF
Fig 13

.FBO
DIBOHFT
NN

SFDPSEFE
JO
USFBU
UPPUI
PS
UFFUI
CFJOH
USFBUFE
5XP
PCMJRVF
NFOU
HSPVQT
BGUFS

NPOUIT
SFMFBTJOH
JODJTJPOT
XFSF
NBEF
BU
UIF

NFTJBM
BOE
EJTUBM
FOET
PG
UIF
IPSJ[POUBM

JODJTJPO
BOE
FYUFOEFE
CFZPOE
UIF
NV
DPHJOHJWBM
KVODUJPO
"
GVMMUIJDLOFTT
nBQ

XBT
SFnFDUFE
CFZPOE
UIF
NVDPHJOHJWBM

KVODUJPO
TP
BT
UP
FYQPTF
BU
MFBTU

NN

PG
CPOF
BQJDBM
UP
UIF
NPTU
BQJDBM
NBSHJO

PG
UIF
CPOZ
EFIJTDFODF
'JH


5IF
nBQ

XBT
GVSUIFS
FMFWBUFE
CZ
TIBSQ
EJTTFD
UJPO
XIJDI
SFMFBTFE
JU
GSPN
UIF
QFSJPT
UFVN
13'
NFNCSBOF
XBT
QPTJUJPOFE
■


13'
o
DPSPOBMMZ
BEWBODFE
nBQ
DPNCJOFE
XJUI
13'
HSPVQ
■ &.%
o
DPSPOBMMZ
BEWBODFE
nBQ
DPNCJOFE
XJUI
FOBNFM
NBUSJY
EFSJWBUJWF
HSPVQ
BOE
TUBCJMJ[FE
XJUI
IPSJ[POUBM
NBUUSFTT

TVUVSFT
JO
UIF
EFTJSFE
QPTJUJPO
'JH



Fig 14

)FBMJOH
JOEFY
)*

SFTVMUT
5IF
nBQ
XBT
BEWBODFE
TP
BT
UP
DPWFS

UIF
13'
NFNCSBOF
BOE
TVUVSFE
XJUI


TJML
'JH




5IF
QPTUTVSHJDBM
QSPUPDPM
XBT
UIF

TBNF
GPS
UIF
UXP
QSPDFEVSFT
1FSJPEPO
UBM
ESFTTJOH
XBT
QMBDFE
BOE
BOUJCJPUJDT

QFOJDJMMJO
7,

NH
FWFSZ

IPVST
GPS
DBM
PSBM
IZHJFOF
DPOTJTUJOH
PG
CSVTIJOH


EBZT

BOE

DIMPSIFYJEJOF
HMV BOE
nPTTJOH
PS
JOUFSQSPYJNBM
CSVTIJOH

DPOBUF
NPVUISJOTF
FWFSZ

IPVST
GPS
BU
UIF
CFHJOOJOH
PG
UIF
UIJSE
QPTUPQ

EBZT

XFSF
QSFTDSJCFE
0SBM
BOBMHF FSBUJWF
XFFL
1BUJFOUT
XFSF
FYBNJOFE

TJDT
JCVQSPGFO

NH
FWFSZ

IPVST
BT
XFFLMZ
VQ
UP

NPOUI
BGUFS
TVSHFSZ
BOE

OFDFTTBSZ

XFSF
BMTP
QSFTDSJCFE UIFO
BU

NPOUIT
'JHT

BOE


1PTU
%SFTTJOH
BOE
TVUVSFT
XFSF
SFNPWFE
PQFSBUJWF
DBSF
JODMVEFE
SFJOGPSDFNFOU

BU

XFFLT
QPTUPQFSBUJWFMZ
4

VSHJDBM
PG
PSBM
IZHJFOF
BOE
NFDIBOJDBM
QMBRVF

XPVOET
XFSF
HFOUMZ
DMFBOTFE
XJUI
SFNPWBM
XIFO
OFDFTTBSZ

DIMPSIFYJEJOF
HMVDPOBUF
PO
B
5IF
WBSJBCMFT
NFBTVSFE
BU
CBTFMJOF

DPUUPO
TXBC
1BUJFOUT
JOJUJBUFE
NFDIBOJ BOE
BU

NPOUIT
JO
CPUI
HSPVQT
XFSF

267
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
"656./

 CLINICAL RESEARCH pyrig
No Co

ht
t fo
rP

by N
ub

Q ui
lica
ti
teXFFLT
on ot

n
HJOHJWBM
SFDFTTJPO
(3

BQJDPDPSPOBM
BOE
UIFSF
XBT
B
NJOJNVN
PG

ss e n c e
fo r
XJEUI
PG
UIF
LFSBUJOJ[FE
UJTTVF
8,5

CFUXFFO
TVSHFSJFT
5IF
CMPPE
IBSWFTU
BOE
QPDLFU
EFQUI
1%

(3
XBT
EFmOFE
JOH
QSPDFEVSF
XBT
OPU
DPOTJEFSFE
JO
UIF

BT
UIF
EJTUBODF
CFUXFFO
UIF
$&+
BOE
QBUJFOU
FWBMVBUJPO
PG
UIF
MFWFM
PG
EJTDPN
UIF
HJOHJWBM
NBSHJO
BU
UIF
NJECVDDBM
GPSU
BTTPDJBUFE
XJUI
UIF
EJGGFSFOU
TVSHJDBM

BTQFDU
PG
UIF
UPPUI
8,5
XBT
UIF
EJT QSPDFEVSFT
UBODF
CFUXFFO
UIF
HJOHJWBM
NBSHJO
BOE
0OFXBZ
BOBMZTJT
PG
WBSJBODF
"/0
UIF
NVDPHJOHJWBM
KVODUJPO
1%
XBT
UIF
7"

XBT
VTFE
UP
DPNQBSF
QSF
BOE

EJTUBODF
CFUXFFO
UIF
HJOHJWBM
NBSHJO
QPTUPQFSBUJWF
DMJOJDBM
NFBTVSFNFOUT

BOE
UIF
CPUUPN
PG
UIF
QPDLFU
"
6OJWFS XJUIJO
UIF
TBNF
HSPVQ
4UVEFOU
t tests
TJUZ
PG
/PSUI
$BSPMJOB
QFSJPEPOUBM
QSPCF
XFSF
VTFE
UP
DPNQBSF
NFBTVSFNFOUT

DBMJCSBUFE
JO

NN
JODSFNFOUT
XBT
VUJ CFUXFFO
UIF
UXP
USFBUNFOU
HSPVQT
1FS
MJ[FE
GPS
BMM
NFBTVSFNFOUT
3FBEJOHT
DFOUBHF
SPPU
DPWFSBHF
XBT
DBMDVMBUFE

XFSF
SPVOEFE
UP
UIF
OFBSFTU

NN
VTJOH
UIF
GPSNVMB

0OF
DBMJCSBUFE
FYBNJOFS
CMJOEFE
UP
UIF

TVSHJDBM
USFBUNFOU
NPEBMJUZ
FNQMPZFE
< (3
BU
CBTFMJOF
¦
(3
BU

NPOUIT



DPMMFDUFE
UIF
EBUB
BU
CBTFMJOF
BOE

(3
BU
CBTFMJOF>
Y


NPOUIT
QPTUPQFSBUJWFMZ
$MJOJDBM
FWBMVBUJPOT
PG
IFBMJOH
FWFOUT
P
WBMVFT
FRVBM
UP
PS
TNBMMFS
UIBO


XFSF
FTUJNBUFE
XJUI
SFDPSEJOHT
PG
UIF
XFSF
SFHBSEFE
BT
TUBUJTUJDBMMZ
TJHOJmDBOU
IFBMJOH
JOEFY
)*

3FDPSEJOHT
PG
)*

XFSF
QFSGPSNFE
PO
UIF
TU
BOE
OE

XFFLT
QPTU
TVSHFSZ
5IF
IFBMJOH
JOEFY 3FTVMUT
TDPSFT
IFBMJOH
PO
UIF
CBTJT
PG
SFEOFTT

QSFTFODF
PG
HSBOVMBUJPO
UJTTVF
CMFFEJOH
%BUB
PO
QSF
BOE
QPTUPQFSBUJWF
DMJOJ
BOE
TVQQVSBUJPO
BOE
FQJUIFMJBMJ[BUJPO
DBM
NFBTVSFNFOUT
BSF
TVNNBSJ[FE
JO

"
TDPSF
PG

UP

JT
HJWFO
XJUI

BTTPDJ 5BCMF

/P
QSFPQFSBUJWF
TJHOJmDBOU
EJG
BUFE
XJUI
WFSZ
QPPS
IFBMJOH
BOE

CFJOH
GFSFODFT
JO
(3
8,5
PS
1%
XFSF
PC
FYDFMMFOU TFSWFE
CFUXFFO
UIF
UXP
HSPVQT
(3
XBT

5IF
TVCKFDUT
PWFSBMM
QPTUPQFSBUJWF
SFEVDFE
GSPN

œ

NN
UP

œ

QBJO
XBT
BTTFTTFE
GPS
UIF
mSTU

EBZT

NN
JO
UIF
13'
HSPVQ
BOE
GSPN


VTJOH
B
IPSJ[POUBM
TDBMF
XJUI
UIF
MFGU
œ

NN
UP

œ

NN
JO
UIF
&.%

FOEQPJOU
NBSLJOH
OP
QBJO


UIF
NJE HSPVQ
(3
DIBOHFT
XJUIJO
FBDI
HSPVQ

EMF
QPJOU
NBSLJOH
QBJO


BOE
UIF
SJHIU
GSPN
CBTFMJOF

BOE
CFUXFFO
HSPVQT

FOEQPJOU
NBSLJOH
TFWFSF
QBJO


5IF
XFSF
TUBUJTUJDBMMZ
TJHOJmDBOU
5IF
NFBO

8JMDPYPO
UFTU
XBT
BQQMJFE
UP
DPNQBSF
EFDSFBTF
PG
(3
XBT

œ

NN

the pain intensity in the postoperative GPS
UIF
13'
HSPVQ
BOE

œ

NN

QFSJPE
"
TJHOJmDBODF
MFWFM
PG

XBT
GPS
UIF
&.%
HSPVQ
BOE
UIJT
EJGGFSFODF

FNQMPZFE
JO
BMM
TUBUJTUJDBM
DPNQBSJTPOT XBT
OPU
TUBUJTUJDBMMZ
TJHOJmDBOU
'JH



Postoperative treatment of one side .FBO
SPPU
DPWFSBHF
XBT

œ


PG
UIF
NPVUI
EJE
OPU
JOnVFODF
UIF
PUIFS
JO
UIF
&.%
HSPVQ
BOE

œ

JO

TJEF
CFDBVTF
UIF
TVSHJDBM
QSPDFEVSFT
UIF
13'
HSPVQ
$PNQMFUF
SPPU
DPWFSBHF

XFSF
OPU
QFSGPSNFE
BU
UIF
TBNF
UJNF
JO
UIF
13'
HSPVQ
XBT


PVU
PG


268
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
"656./

 JANKOVIC ET ALopyrig
No C

ht
t fo
rP

by N
ub

Q ui
lica
tio
te n ot

n
Table 1

$MJOJDBM
QBSBNFUFST
NFBTVSFE
BU
CBTFMJOF
BOE
BU

NPOUIT
QPTUPQFSBUJWFMZ
O



ss e n c e fo r
Baseline 12 months

EMD PRF EMD P PRF P

(3 
œ
 
œ
 
œ
pq  
œ
pq 

3$ NA NA 
œ
q 
œ
q

WKT 
œ
 
œ
 
œ
  
œ
 

PD 
œ
 
œ
 
œ
  
œ
 

&.%
o
DPSPOBMMZ
BEWBODFE
nBQ
DPNCJOFE
XJUI
FOBNFM
NBUSJY
EFSJWBUJWF
13'
o
DPSPOBMMZ
BEWBODFE
nBQ
DPNCJOFE
XJUI
QMBUFMFUSJDI
mCSJO
NFNCSBOF

(3
o
HJOHJWBM
SFDFTTJPO
JO
NJMMJNFUFST
3$
o
QFSDFOUBHF
SPPU
DPWFSBHF
DBMDVMBUFE
CZ


< (3
BU
CBTFMJOF
¦
(3
BU

NPOUIT


(3
BU
CBTFMJOF>
Y

8,5
o
BQJDPDPSPOBM
XJEUI
PG
UIF
LFSBUJOJ[FE
UJTTVF
JO
NJMMJNFUFST
PD – pocket depth in millimeters
/"
o
OPU
BQQMJDBCMF
p
4UBUJTUJDBMMZ
TJHOJmDBOUMZ
EJGGFSFOU
GSPN
CBTFMJOF
XJUIJO
UIF
HSPVQ
P



q
4UBUJTUJDBMMZ
TJHOJmDBOUMZ
EJGGFSFOU
CFUXFFO
UIF
UXP
USFBUNFOU
HSPVQT
P



SFDFTTJPOT

BOE

JO
UIF
&.%
HSPVQ
Table 2

1BJO
JOUFOTJUZ
JO
UIF
mSTU

EBZT
BGUFS
TVS
HFSZ
O




PG
PVU

SFDFTTJPOT

*O
UIF
&.%
HSPVQ
8,5
JODSFBTFE
Pain intensity
GSPN

œ

NN
BU
CBTFMJOF
UP

Day EMD PRF P
œ

NN
BU

NPOUIT
4JUFT
USFBUFE
 
œ
 
œ
 
XJUI
13'
TIPXFE
BO
JODSFBTF
JO
8,5
 
œ
 
œ
 
GSPN

œ

NN
BU
CBTFMJOF
UP

 
œ
 
œ
 
œ

NN
BU

NPOUIT
1SF
BOE
QPTU  
œ
 
œ
 
PQFSBUJWF
EJGGFSFODFT
XJUIJO
HSPVQT
5 
œ
 
œ
 
XFSF
OPU
TUBUJTUJDBMMZ
TJHOJmDBOU
5IF
 
œ
 
œ
 
NFBO
NPOUI
JODSFBTF
PG
8,5
PC  
œ
 
œ
 
TFSWFE
JO
UIF
&.%
HSPVQ
XBT

œ
4UBUJTUJDBMMZ
TJHOJmDBOU
P




NN
BOE
JO
UIF
13'
HSPVQ
JU
XBT


œ

NN
'JH


5IF
EJGGFSFODF

CFUXFFO
UIF
UXP
HSPVQT
XBT
TUBUJTUJDBM
MZ
TJHOJmDBOU
GBWPSJOH
UIF
&.%
HSPVQ
XFFLT
BGUFS
TVSHFSZ
TIPXFE
B
IJHI
MFWFM

1%
NFBTVSFNFOUT
XFSF
OPU
TJHOJm PG
FRVJWBMFODF

œ

BOE

œ

DBOUMZ
EJGGFSFOU
CFUXFFO
CBTFMJOF
BOE

P




NPOUIT
XJUIJO
UIF
USFBUNFOU
HSPVQT
3FHBSEJOH
UIF
QPTUPQFSBUJWF
QFSJPE

OPS
XFSF
QPTUPQFSBUJWF
EJGGFSFODFT
CF UISFF
QBUJFOUT
JO
UIF
&.%
HSPVQ
FYQFSJ
UXFFO
UIF
UXP
HSPVQT
FODFE
TFWFSF
QBJO
DPNQBSFE
XJUI
POF

3FTVMUT
PG
)*
PCUBJOFE
JO
UIF
13'
HSPVQ
JO
UIF
13'
HSPVQ
"MM

QBUJFOUT
JO
UIF

BGUFS

XFFL
PG
TVSHFSZ
XFSF
TUBUJTUJDBMMZ
&.%
HSPVQ
JOEJDBUFE
HSFBUFS
EJTDPN
TJHOJmDBOUMZ
TVQFSJPS
JO
SFMBUJPO
UP
UIF
GPSU
5IF
QBJO
JOUFOTJUZ
XBT
TUBUJTUJDBMMZ

EBUB
SFDPSEFE
JO
&.%
HSPVQ
P



TJHOJmDBOUMZ
EJGGFSFOU
CFUXFFO
HSPVQT
GPS

'JH


3FDPSEJOHT
PG
UIF
)*
PCUBJOFE
UIF
mSTU

EBZT
GBWPSJOH
UIF
13'
HSPVQ

JO
UIF
13'
HSPVQ
BOE
UIF
&.%
HSPVQ
UXP
TFF
5BCMF



269
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
"656./

 CLINICAL RESEARCH pyrig
No Co

ht
t fo
rP

by N
ub

Q ui
lica
ti
te evi on ot

n
%JTDVTTJPO Therefore, there is no consistentss e n c e
fo r
EFODF
TVHHFTUJOH
UIBU
TVSHJDBM
UFDI
5IF
QSFTFOU
TUVEZ
DPNQBSFE
UIF
FGGFD OJRVFT
FNQMPZJOH
13'
BSF
TVQFSJPS
UP

UJWFOFTT
PG
UXP
QFSJPEPOUBM
QMBTUJD
TVSHJ UFDIOJRVFT
VUJMJ[JOH
&.%
DPNCJOFE
XJUI

DBM
QSPDFEVSFT
JO
BDIJFWJOH
DPWFSBHF
PG
$"'
JO
BDIJFWJOH
SPPU
DPWFSBHF
FYQPTFE
SPPUT
EVF
UP
MPDBMJ[FE
HJOHJWBM
1PTTJCMF
BEWBOUBHFT
NBZ
CF
SFMBUFE

SFDFTTJPO
.FBO
SPPU
DPWFSBHF
BDIJFWFE
to the marked increase in WKT achieved
XJUI
UIF
$"'
DPNCJOFE
XJUI
&.%
JO
UIJT
XJUI
UIF
&.%
UFDIOJRVF
BT
PQQPTFE
UP

TUVEZ
XBT

BU

NPOUIT
QPTU UIF
NPSFUIBONPEFTU
JODSFBTF
JO
UIF

PQFSBUJWFMZ
5IFTF
SFTVMUT
BSF
WFSZ
TJNJMBS
TBNF
QBSBNFUFS
PCUBJOFE
XJUI
UIF
$"'

UP
UIF
POFT
SFQPSUFE
CZ
/FNDPWTLZ  QMVT
13'
"
OBSSPX
CBOE
PG
BUUBDIFE

XIFSF
SPPU
DPWFSBHF
BU

NPOUIT
XBT
HJOHJWB
IBT
CFFO
SFDPHOJ[FE
BT
B
QSF

BOE
.PEJDB
FU
BM
XIFSF
JU
XBT
EJTQPTJOH
GBDUPS
GPS
HJOHJWBM
SFDFTTJPO
 It is important to mention that 5IF
&.%
HSPVQ
JO
UIJT
TUVEZ
QSFTFOU
PUIFS
TUVEJFT
IBWF
SFQPSUFE
IJHIFS
SBUFT
FE
XJUI
B
OPUBCMF
JODSFBTF
JO
8,5
BU

PG
SPPU
DPWFSBHF
TVDDFTT
XJUI
UIF
$"'

NPOUIT
DPNQBSFE
UP
CBTFMJOF
5IBU

DPNCJOFE
XJUI
&.%
1JMMPOJ
FU
BM re JODSFBTF
XBT
BQQSPYJNBUFMZ

NN

QPSUFE
B

NFBO
TVDDFTT
SBUF
JO
UIF
5IF
13'
HSPVQ
TIPXFE
B
NFBO
HBJO
PG

USFBUNFOU
PG
HJOHJWBM
SFDFTTJPO
BGUFS


NN
PG
8,5
BGUFS

NPOUIT
"SPDB

NPOUIT
5IF
SFBTPO
GPS
UIJT
EJTDSFQBODZ
FU
BM
EJE
OPU
DPOmSN
BOZ
HBJO
PG
8,5
JO

CFUXFFO
EBUB
GSPN
UIF
QSFTFOU
TUVEZ
BOE
UIF
13'
HSPVQ
BGUFS

NPOUIT

5IF
EJGGFS
1JMMJPOJT
SFTVMUT
NBZ
CF
SFMBUFE
UP
WBSJB FODF
PCTFSWFE
CFUXFFO
UIF
UXP
HSPVQT

UJPOT
PG
VONFBTVSFE
QBSBNFUFST
TVDI
BT
JO
BVHNFOUJOH
LFSBUJOJ[FE
UJTTVF
XJEUI

nBQ
UIJDLOFTT
BOE
nBQ
UFOTJPO BU

NPOUIT
XBT
TUBUJTUJDBMMZ
TJHOJmDBOU


5IF
SPPU
DPWFSBHF
TVDDFTT
SBUF
PC GBWPSJOH
UIF
&.%
HSPVQ
UBJOFE
XJUI
UIF
$"'
DPNCJOFE
XJUI
&.%
'SPN
UIJT
PCTFSWBUJPO
JU
DPVME
CF
JO
JO
UIJT
TUVEZ
TIPXFE
TJHOJmDBOU
SFEVD ferred that EMD may have a modest
UJPO
PG
USFBUFE
HJOHJWBM
SFDFTTJPO
BOE
B
FGGFDU
JO
JOEVDJOH
LFSBUJOJ[BUJPO
PG
UIF

IJHI
MFWFM
PG
FRVJWBMFODF
UP
UIF
SFTVMUT
HJOHJWBM
FQJUIFMJVN
"
SFQPSU
CZ
)ÚHFM
SFDPSEFE
GPS
$"'
DPNCJOFE
XJUI
13'
*O
XBME
IBT
TVHHFTUFE
TVDI
BO
FGGFDU

UIF
QSFTFOU
TUVEZ
SFDPSEFE
NFBO
SPPU
GSPN
&.%
PO
HJOHJWBM
FQJUIFMJB
5IF
BCJM
DPWFSBHF
BDIJFWFE
JO
UIF
13'
HSPVQ
JUZ
PG
&.%
UP
JODSFBTF
8,5
IPXFWFS
JT

XBT

BGUFS
UIF
PCTFSWBUJPO
QFSJPE
DMFBSMZ
OPU
BT
DMJOJDBMMZ
TJHOJmDBOU
BT
UIF


NPOUIT

"SPDB
FU
BM
QSFTFOUFE
NFBO
POF
PCTFSWFE
XJUI
$5(
SPPU
DPWFSBHF
PG

BGUFS

NPOUIT
5IF
DVSSFOU
TUVEZ
EJE
OPU
QSPWJEF
EBUB

VUJMJ[JOH
13'
$PNQMFUF
SPPU
DPWFSBHF
UP
FWBMVBUF
UIF
BEEJUJPOBM
FGGFDUT
PG
&.%

JO
UIF
13'
HSPVQ
XBT


PVU
PG

UP
UIF
$"'
JO
SPPU
DPWFSBHF
QSPDFEVSFT

SFDFTTJPOT

BOE

JO
UIF
&.%
HSPVQ
BT
UIF
HSPVQ
USFBUFE
XJUI
UIF
$"'
BMPOF


PVU
PG

SFDFTTJPOT

5IF
POMZ
QVC XBT
OPU
QBSU
PG
UIF
SFTFBSDI
QSPUPDPM

MJTIFE
TUVEZ
SFHBSEJOH
UIF
VUJMJ[BUJPO
PG
)PXFWFS
B
TUVEZ
CZ
%FM
1J[[P
FU
BM
13'
JO
UIF
USFBUNFOU
PG
HJOHJWBM
SFDFT SFWFBMFE
UIBU
B
DPNCJOBUJPO
PG
&.%

sion presented complete root cover XJUI
UIF
$"'
EJE
OPU
SFTVMU
JO
BEEJUJPOBM

BHF
JO
UIF
13'
HSPVQ
PG
POMZ
 SPPU
DPWFSBHF
BT
DPNQBSFE
UP
UIF
$"'

270
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
"656./

 JANKOVIC ET ALopyrig
No C

ht
t fo
rP

by N
ub

Q ui
lica
tio
te n
ot

n
VTFE
BMPOF
0O
UIF
PUIFS
IBOE
1JMMPOJ PG
DPODFOUSBUFE
1%('
7&('
BOE
5('
ss e n c e
fo r
SFWFBMFE
TJHOJmDBOU
PVUDPNF
JNQSPWF UIF
NBJO
HSPXUI
GBDUPST
GSPN
13'
5IFTF

NFOUT
JO
B
HSPVQ
XJUI
HJOHJWBM
SFDFTTJPO
HSPXUI
GBDUPST
NJHIU
FOIBODF
TPGU
UJTTVF

USFBUFE
XJUI
&.%
BOE
B
$"'
DPNQBSFE
IFBMJOH
CZ
JODSFBTJOH
UIF
BOHJPHFOFTJT

UP
UIF
HSPVQ
USFBUFE
XJUI
$"'
BMPOF
5IF
BOE
NBUSJY
CJPTZOUIFTJT
EVSJOH
XPVOE

QPUFOUJBM
BEWBOUBHF
BTTPDJBUFE
XJUI
IFBMJOH
&.%
JT
SFMBUFE
UP
UIF
OBUVSF
PG
UIF
BU 4PNF
SFDFOU
TUVEJFT
FNQIBTJ[FE

UBDINFOU
CFUXFFO
UIF
TPGU
UJTTVF
BOE
UIF
UIBU
HJOHJWBM
UJTTVF
UIJDLOFTT
JT
FTTFO
SPPU
TVSGBDF
#FDBVTF
PG
JUT
NFDIBOJTN
UJBM
UP
NFBO
PS
DPNQMFUF
SPPU
DPWFSBHF

of action, EMD may enhance the devel BOE
TUBCJMJUZ
PG
DMJOJDBM
PVUDPNF
BOE
BO

PQNFOU
PG
USVF
DPOOFDUJWF
BUUBDINFOU
JODSFBTF
JO
UJTTVF
UIJDLOFTT
IBT
CFFO

XIFO
B
nBQ
JT
DPSPOBMMZ
BEWBODFE
)JT EFTDSJCFE
GPMMPXJOH
$5( 
5P
UIF
BV
UPMPHJDBM
SFQPSUT
IPXFWFS
TIPX
DPOUSP UIPST
LOPXMFEHF
UIFSF
JT
POMZ
POF
QVC
WFSTJBM
SFTVMUT
BT
UP
UIF
BCJMJUZ
PG
&.%
UP
lication
UIBU
TFQBSBUFT
SPPU
DPWFSBHF

JOEVDF
QFSJPEPOUBM
SFHFOFSBUJPO
GPMMPX CZ
UZQF
PS
IFBMJOH
QBUUFSO
XJUI
SFTQFDU

JOH
SPPU
DPWFSBHF
QSPDFEVSFT
While UP
UJTTVF
UIJDLOFTT
"SPDB
FU
BM
TIPXFE

UXP
TUVEJFT
TIPXFE
OFHMJHJCMF
BNPVOUT
B
OPUBCMF
JODSFBTF
JO
HJOHJWBM
UIJDLOFTT

PG
QFSJPEPOUBM
SFHFOFSBUJPO    one BGUFS

NPOUIT
JO
B
HSPVQ
USFBUFE
XJUI

SFQPSU
EFTDSJCFE
B
TJHOJmDBOU
FYUFOU
13'
5IJT
NBZ
CF
UIF
SFTVMU
PG
HJOHJWBM

PG
QFSJPEPOUBM
SFHFOFSBUJPO
PDDVSSJOH
BOE
QFSJPEPOUBM
MJHBNFOU
mCSPCMBTU
QSP
XIFO
VUJMJ[JOH
&.%
JO
SPPU
DPWFSBHF
QSP liferation related to the impact of con
DFEVSFT
5IPTF
QVCMJTIFE
IVNBO
IJT DFOUSBUFE
HSPXUI
GBDUPST
GSPN
13'
*O
UIF

UPMPHZ
TUVEJFT
PG
UIF
DPOOFDUJWF
UJTTVF
QSFTFOU
TUVEZ
UIF
BVUIPST
EJE
OPU
QFS
HSBGU
XFSF
QFSGPSNFE
XJUIPVU
DBMDVMVT
GPSN
HJOHJWBM
UJTTVF
UIJDLOFTT
BTTFTT
OPUDI
NFOU
JO
UIF
13'
BOE
&.%
HSPVQT
CFGPSF

5IF
CJPMPHJDBM
JNQBDU
PG
FOBNFM
NB TVSHFSZ
BOE
BGUFS
UIF
FWBMVBUJPO
QFSJPE

USJY
QSPUFJOT
NJHIU
FOIBODF
TPGU
UJTTVF
'VUVSF
TUVEJFT
XJMM
FWBMVBUF
UIJT
QBSBN
IFBMJOH
CZ
JODSFBTJOH
UIF
BOHJPHFOFTJT
FUFS
BT
B
QSPNJTJOH
QPUFOUJBM
QSFEJDUPS

BOE
NBUSJY
CJPTZOUIFTJT
EVSJOH
XPVOE
PG
SPPU
DPWFSBHF
5IFTF
TUVEJFT
XJMM

IFBMJOH provide additional information related to
3FTVMUT
PG
UIF
IFBMJOH
JOEFY
JOEJDBU UIF
FGmDBDZ
PG
13'
VUJMJ[BUJPO
JO
HJOHJWBM

FE
OPUFXPSUIZ
JNQSPWFNFOUT
PG
FBSMZ
SFDFTTJPO
USFBUNFOU

XPVOE
IFBMJOH
mSTU
XFFL
QPTU
TVSHFSZ

*O
PSEFS
UP
CF
NPSF
QSFDJTF
BOE
PC
JO
UIF
HSPVQ
USFBUFE
XJUI
13'
NFNCSBOF
KFDUJWF
JU
IBT
UP
CF
FNQIBTJ[FE
UIBU
UIF

DPNQBSFE
UP
UIF
HSPVQ
USFBUFE
XJUI
QSFTFOU
SFTVMUT
JO
UFSNT
PG
SPPU
DPWFS
&.%
5IJT
PVUDPNF
NBZ
CF
SFMBUFE
UP
BHF
QFSDFOUBHF
BOE
DPNQMFUF

BOE
JO
UIF
FYUSFNFMZ
FMFWBUFE
EFOTJUZ
PG
mCSJO
DSFBTF
JO
CVDDBM
LFSBUJOJ[FE
UJTTVF
EPFT

mCFST
EFUFDUFE
JO
UIF
13'
NFNCSBOF
OPU
TFFN
UP
CF
TVQFSJPS
UP
UIPTF
SFDFOUMZ

"
IJHI
EFOTJUZ
PG
mCSJO
mCFST
QSPWJEFT
QVCMJTIFE
GPS
UIF
$"'
BMPOF 
BEEJUJPOBM
TUBCJMJUZ
UP
UIF
XPVOE
BOE
QSP #PUI
FWBMVBUFE
TVSHJDBM
UFDIOJRVFT

NPUFT
SBQJE
OFPBOHJPHFOFTJT The im QSPWFE
UP
CF
DMJOJDBMMZ
TVDDFTTGVM
JO
UIF

provements of HI achieved in the PRF USFBUNFOU
PG
HJOHJWBM
SFDFTTJPO
$MJOJ
HSPVQ
DPVME
BMTP
CF
FYQMBJOFE
BT
BDUJPO
DBM
JNQMJDBUJPOT
BOE
NJOPS
BEWBOUBHFT

271
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
70-6.&

t
/6.#&3

t
"656./

 CLINICAL RESEARCH pyrig
No Co

ht
t fo
rP

by N
ub

Q ui
lica
tio
TVDDFFE
JO
EFNPOTUSBUJOH
BOZ
t e
n ot

n
PG
13'
NFNCSBOF
VTF
BT
HSBGU
NBUFSJBM
DMJOJDBM

ss e n c e fo r
BSF
SFMBUFE
UP
BEWBODFE
UJTTVF
IFBMJOH
BEWBOUBHF
PG
UIF
VTF
PG
13'
DPNQBSFE

EVSJOH
UIF
mSTU
XFFL
QPTU
TVSHFSZ
BOE
UP
&.%
JO
UIF
DPWFSBHF
PG
HJOHJWBM
SF
B
EFDSFBTF
JO
QBUJFOU
EJTDPNGPSU
EVSJOH
DFTTJPO
XJUI
UIF
$"'
QSPDFEVSF
"MTP

UIF
FBSMZ
XPVOE
IFBMJOH
QFSJPE
5IF
BE JU
NVTU
CF
NFOUJPOFE
UIBU
UIF
CMPPE
DPM
WBOUBHF
PG
FBSMZ
IFBMJOH
FWFOUT
SFMBUFE
MFDUJPO
QSPDFEVSF
MJOLFE
UP
13'
QSFQB
UP
UIF
VTF
PG
13'
XBT
SFDPSEFE
POMZ
EVS ration presents additional discomfort for
JOH
UIF
mSTU
XFFL
QPTUPQFSBUJWFMZ
CVU
BQ UIF
QBUJFOU

QBSFOUMZ
JU
EPFT
OPU
NBLF
B
OPUFXPSUIZ
"
QPTTJCMF
QPTJUJWF
UFOEFODZ
PG
13'

JNQBDU
PO
UIF
ZFBS
DMJOJDBM
PVUDPNF
VUJMJ[BUJPO
TIPVME
CF
CFUUFS
FWBMVBUFE

0O
UIF
PUIFS
IBOE
&.%
VUJMJ[BUJPO
QSP JO
TUVEJFT
JOWPMWJOH
B
MBSHFS
OVNCFS
PG

WJEFT
CFUUFS
8,5
BVHNFOUBUJPO TVCKFDUT
/P
IJTUPMPHJDBM
FWBMVBUJPO
XBT

0O
UIF
CBTJT
PG
UIF
SFTVMUT
BDIJFWFE
QFSGPSNFE
JO
UIF
QSFTFOU
TUVEZ
UIFSFGPSF

JO
UIF
QSFTFOU
SFTFBSDI
JU
NVTU
CF
FN UIF
FGGFDU
PG
13'
PO
PWFSBMM
SFHFOFSBUJPO

QIBTJ[FE
UIBU
UIF
QSFTFOU
TUVEZ
EJE
OPU
DBQBDJUZ
SFNBJOT
UP
CF
EFUFSNJOFE

References


.BUUFS
+
'SFF
HJOHJWBM
HSBGU
therapies for the treatment of 
)BSSJT
3+
(53
GPS
SPPU
DPW
and coronally repositioned HJOHJWBM
SFDFTTJPO
B
TZTUFN FSBHF
B
MPOHUFSN
GPMMPXVQ

nBQ
B
ZFBS
GPMMPXVQ
BUJD
SFWJFX
"OO
1FSJPEPOUPM
Int J Periodontics Restorative
SFQPSU
+
$MJO
1FSJPEPOUPM
o %FOU
o
o 

&EFM
"
5IF
VTF
PG
B
GSFF

8FOOTUSÚN
+-
1JOJ
1SBUP
(



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273
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
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"656./

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